The other two cases in the nonvisible gallbladder group and indeed all other cases in this series had no recorded early complications. This study is limited by its size and retrospective nature. The patients were selected selleckchem Axitinib from a cohort of children who had undergone cholecystectomy, a small proportion of these children had been noted to have a ultrasonographically nonvisible gallbladder. A formal study examining the potential link between this finding in children with symptomatic gallbladder dyspepsia and the diagnosis of CAC would be difficult to establish prospectively due to the rarity of these circumstances. We must, however, remain circumspect as to the nature of these findings.

This is a small series of paediatric cholecystectomies with an interesting observation; that in 3 cases the gallbladder could not be seen on repeated competent ultrasound examinations in the context of recurrent right upper quadrant abdominal pain. The final diagnosis in these cases was chronic acalculous cholecystitis. Published literature pertaining to imaging CAC does not discuss this. We would like to propose that early consideration is given to performing laparoscopic cholecystectomy when a child presents with intractable gallbladder dyspepsia and a nonvisible gallbladder on ultrasound scan. 4. Conclusion Sonographic nonvisualisation of the gallbladder in patients with intractable gall bladder dyspepsia may suggest the possibility of a chronically scarred organ for which a cholecystectomy is indicated. Conflict of Interests The authors declare that they have no conflict of interests.

Acknowledgments The authors are grateful to the International Pediatric Endosurgery Group for enabling presentation of this data in a poster at their 21st Annual Congress in San Diego, CA, USA. Requests for reprints should be directed to the corresponding author.
Inguinal hernia (IH) repair is one of the most frequently performed surgical procedures in infants and children. Open herniotomy is its standard treatment against which all alternative modalities of treatment are evaluated. It is credited with being easy to perform, having a high success rate, and low rate of complications. However, recently, many centers routinely perform laparoscopic hernia repair in children and there have been numerous reports describing various laparoscopic techniques rather than the traditional open approach [1�C4].

Reported advantages of laparoscopic hernia repair include excellent visual exposure, minimal dissection, less complications, comparable recurrence rates, and improved cosmetic results compared with the traditional open approach. In addition, laparoscopic hernia repair also allows contralateral patent process vaginalis (PPV) hernias to be defined and repaired in the same operation Brefeldin_A [5�C7]. Randomized control study of laparoscopic hernia repair versus OH in pediatrics is rare in the literature [8�C10].